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Daniel Extra, MD, is a board-certified allergist and scientific immunologist with a background in inner medication.
Corinne Savides Happel, MD, is a board-certified allergist and immunologist with a concentrate on allergic pores and skin issues, bronchial asthma, and different immune issues.
An allergy to cobalt could be triggered by taking vitamin B12 (cobalamin) for the reason that cobalamin molecule comprises a cobalt atom. Taking giant quantities of vitamin B12 (in both oral or injectable types) might end in contact dermatitis, producing rashes and itching in folks with a historical past of cobalt allergy.
There have been some case stories of sufferers growing these reactions in affiliation with vitamin B12 supplementation. Contact dermatitis is a rash that’s not often life-threatening. The uncommon situation of vitamin B12 allergy could be life-threatening, though there are few stories of it within the medical literature.
Allergic Contact Dermatitis to Cobalt and Vitamin B12 Allergy
Signs
Contact dermatitis is a crimson, typically blistering pores and skin rash usually brought on by the direct contact of a substance with the pores and skin. There are two kinds of contact dermatitis: irritant and allergic.
Whereas irritants will trigger irritant dermatitis for many people who find themselves uncovered to ample quantities of the offending chemical, allergens will solely trigger allergic contact dermatitis in people who find themselves sensitized (that’s, allergic) to these substances.
Contact dermatitis ends in thousands and thousands of physician visits every year in the US, and all ages are affected. Analysis means that 20% of all individuals are affected by this situation. Females are barely extra generally affected than males, and youngsters and middle-aged adults appear to be the most typical age teams affected.
Not often, intramuscular injections of vitamin B12 have additionally been related to life-threatening anaphylaxis. The signs of anaphylaxis might embody itching, hives, shortness of breath, wheezing, vomiting, diarrhea, or anaphylactic shock.
Causes
Vitamin B12, additionally known as cobalamin, is a water-soluble vitamin that performs an necessary position within the formation of blood cells and within the regular operate of the nervous symptom. Cobalamin is often out there from dietary sources, and most multivitamins include an quantity of vitamin B12 sufficient for good well being.
Vitamin B12 Deficiency
The absorption of vitamin B12 could be very difficult: it contains numerous steps which can be liable to defects, which might result in poor absorption of vitamin B12 from the small gut. In consequence, vitamin B12 deficiency is comparatively frequent.
Folks affected by this situation may have oral or injectable vitamin B12 dietary supplements. Different folks take giant quantities of vitamin B12, significantly with different types of vitamin B—termed vitamin B complicated—hoping to achieve “improved health.”
Cobalt and Vitamin B12 Allergy
Cobalt allergy usually presents when an individual who’s uncovered to cobalt in cosmetics (eye make-up, particularly), in tattoos, or in industrial merchandise develops an itchy, crimson, scaly rash that may typically even blister.
If a affected person turns into sensitized to cobalt, they may develop a rash (allergic contact dermatitis) after re-exposure (i.e., pores and skin contact) to cobalt. Whereas these reactions will not be more likely to be harmful, they can lead to an uncomfortable itchy rash. Nevertheless, this isn’t the way in which most instances of cobalt contact allergy current.
Folks with vitamin B12 deficiency and cobalt allergy ought to subsequently solely take as a lot vitamin B12 as is required to take care of sufficient ranges.
Analysis
Cobalt allergy prognosis is made with a patch check, which includes the position of cobalt, together with different chemical substances, on the again for roughly 48 hours (it isn’t the identical as allergy pores and skin prick testing). This usually is finished with a paper tape system, such because the TRUE check.
The TRUE check is the one FDA-approved check for contact dermatitis in the US, though some allergists and dermatologists will develop extra intensive patch check panels with chemical substances bought from Canada or Europe.
The outcomes of the check are interpreted at 48 hours after placement, and once more at 72 or 96 hours after placement.
A constructive check is confirmed when there are blisters, redness, and/or gentle swelling on the web site of the actual chemical in query. The positioning of the constructive check often itches, though the response measurement is often restricted to the positioning of contact and subsequently is often smaller than a dime.
Therapy – “b vitamin rash”
The rash related to cobalt allergy contact dermatitis could be handled with topical corticosteroids or systemic corticosteroids (oral versus injectable). Nevertheless, cobalt allergy is greatest handled with avoidance of enormous doses of vitamin B12.
Folks with vitamin B12 deficiency ought to solely take the minimal quantity of vitamin B12 that it takes to take care of regular ranges of vitamin B12, as measured by a blood check.